Mohs Surgery 

What is Mohs surgery?

Mohs surgery, also called Mohs micrographic surgery, is an advanced surgical technique used to remove skin cancer. A Mohs surgeon, typically a dermatologist who has undergone specialized fellowship training, removes the cancerous lesion very carefully one skin layer at a time. Each layer is examined closely under the microscope to ensure all cancer cells are fully removed. If cancer cells are visible, another thin layer is removed and examined, repeating the process until no cancer cells are detected under the microscope.

This process ensures the cancer is fully removed while minimizing the amount of healthy tissue loss. For many types of skin cancer, Mohs surgery is the most precise form of skin cancer surgery, and has a very high cure rate, extremely low recurrence rate and minimizes tissue loss. 

What is post-Mohs reconstructive surgery?

Mohs surgery is a crucial step in skin cancer removal, but patients are often left with a large and/or complex open wound. After your cancer has been fully removed by the Mohs surgeon, post-Mohs reconstructive surgery is performed by a specialized facial plastic surgeon, such as Dr. Williams, who closes the wound, restores function and minimizes the appearance of the defect. 

Preparing for Surgery

What to expect

In some cases, you’ll meet with Dr. Williams prior to your Mohs surgeon removing your skin cancer. That will allow proper planning and measurements to be taken. However, many times patients are referred to Dr. Williams after the cancer has already been removed. Dr. Williams will explain the reconstruction process, answer questions, take measurements, plan his repair technique and discuss goals and expectations with the patient during their visit. Once the cancer is removed, Dr. Williams’ team will work closely with the Mohs surgeon’s team to schedule the post-Mohs reconstruction to close the defect as soon as possible. Depending on scheduling, this typically will occur within a week but usually within a few days. The majority of reconstructive surgeries occur in a single stage, however there are specific post-Mohs defects that mandate multiple stage procedures. If this is required, a thorough discussion will occur about the steps involved, why a multiple stage procedure is necessary and the timeline in which the procedures will occur.

Certain types of skin cancer require evaluation of nearby lymph nodes to see if any cancer cells have spread (metastasized). When this is indicated, Dr. Williams is able to perform lymph node biopsies as part of complete cancer care. 

Depending on the severity and location of the defect, you will have an in-office procedure under local anesthesia or under general anesthesia at a surgery center or hospital. This is typically a same day outpatient surgery and an overnight stay is rare, but possible. 

Post-operative expectations

After your reconstructive surgery, you can expect varying amounts of swelling, oozing from the incision, tightness, bruising and pain that predictably decreases during the first few days and weeks. These are all normal and expected outcomes and very manageable with close adherence to provided post-operative instructions. You will be prescribed antibiotics and appropriate pain medications and educated about proper wound care.

Dr. Williams personally checks in with all Mohs reconstruction patients within 24 hours of their procedure. The office is also always available by phone or text message. The procedure can be overwhelming so questions or concerns are always encouraged to be sent to the office or to Dr. Williams.

Finally, the Mohs surgeon and/or general dermatologist involved in the diagnosis and removal of the cancer, will be kept updated about patient’s progress and healing. 

Dr. Williams’ office accepts most major insurance as well as Medicare. The scheduling staff can provide a full cost estimate prior to your procedure. Most insurances tend to cover post-Mohs reconstructive surgery costs and there are no additional out of pocket fees for you to see a plastic surgeon for your procedure.